Exercise-induced intestinal barrier dysfunction: a potential contributor to athlete mental health

Athlete mental health has become a growing concern across endurance, aesthetic and weight-sensitive sports. While psychosocial factors play major roles, emerging evidence suggests biological pathways related to gastrointestinal function may contribute. Intense exercise induces transient intestinal barrier dysfunction through splanchnic hypoperfusion, hyperthermia and tight-junction disruption, increasing permeability and microbial product exposure. These changes resemble biomarker patterns in psychiatric populations, where elevated zonulin, lipopolysaccharide and intestinal fatty-acid binding protein are associated with anxiety, depression and neuroinflammation.

This viewpoint proposes a bidirectional model linking exercise-induced gut barrier stress and mood disturbance. Gut-derived signals including vagal afferent activation and cytokine-mediated tryptophan-kynurenine shifts may influence mood-regulating brain regions, while psychological stress reciprocally impairs gut integrity via corticotropin-releasing hormone and sympathetic activation. Female athletes may face heightened vulnerability through hypoestrogenic states and psychosocial pressures.

While exercise physiology and psychiatric literatures remain separate, their convergence highlights an under-recognised dimension of athlete health warranting clinical awareness and Relative Energy Deficiency in Sport integration. Research priorities include longitudinal athlete studies and multi-omics approaches to determine whether gut barrier dysfunction is a contributor, modifier or parallel correlate of athlete mental health.